1
|
Treichel AM, Zheng DX, Ranasinghe GC, Zeft AS, Bergfeld WF, Bayart CB. Eosinophilic fasciitis in a young male auto mechanic exposed to organic solvents. Reumatismo 2023; 75. [PMID: 37721352 DOI: 10.4081/reumatismo.2023.1539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 07/08/2023] [Indexed: 09/19/2023] Open
Abstract
We report a case of eosinophilic fasciitis in a teenage auto mechanic who was most likely affected by occupational exposure to organic solvents, including the aromatic hydrocarbons benzene, trimethylbenzene, naphthalene, toluene, and xylene. The patient presented with an 8-month history of painful induration of his extremities and an abnormal gait. A deep excisional biopsy of the fascia was obtained, demonstrating subcutaneous fibrosis with perivascular and interstitial inflammation, with lymphocytes and plasma cells spilling into the sclerosed fascia, and focal fibrinoid necrosis. Treatment was begun with intravenous pulse doses of methylprednisolone, prednisone (20 mg daily), and subcutaneous methotrexate (25 mg weekly), and the patient's painful induration had resolved and gait had normalized at the 6-month follow-up. Our case suggests that exposure to organic solvents could be implicated in the pathogenesis of eosinophilic fasciitis and highlights the importance of a thorough occupational history to prevent repeat exposures to potentially causative agents.
Collapse
Affiliation(s)
- A M Treichel
- Department of Dermatology, Cleveland Medical Center University Hospital, Case Western Reserve University, Cleveland, Ohio.
| | - D X Zheng
- Department of Dermatology, Cleveland Medical Center University Hospital, Case Western Reserve University, Cleveland, Ohio.
| | | | - A S Zeft
- Division of Pediatric Rheumatology, Department of Pediatrics, Cleveland Clinic, Ohio.
| | - W F Bergfeld
- Department of Dermatology, Cleveland Clinic, Ohio.
| | - C B Bayart
- Department of Pediatric Dermatology, Cincinnati Children's Hospital Medical Center, Ohio.
| |
Collapse
|
2
|
Murad A, Bergfeld WF. Prostaglandin analogue for eyebrow loss in frontal fibrosing alopecia: a case report. J Eur Acad Dermatol Venereol 2019; 33:e403-e405. [PMID: 31119795 DOI: 10.1111/jdv.15704] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- A Murad
- Department of Dermatology, The Mater Misericordiae University Hospital, Dublin 7, Ireland.,Department of Dermatology and Dermatopathology, The Cleveland Clinic Foundation, Cleveland, OH, USA
| | - W F Bergfeld
- Department of Dermatology and Dermatopathology, The Cleveland Clinic Foundation, Cleveland, OH, USA
| |
Collapse
|
3
|
Brankov N, Conic RZ, Atanaskova-Mesinkovska N, Piliang M, Bergfeld WF. Comorbid conditions in lichen planopilaris: A retrospective data analysis of 334 patients. Int J Womens Dermatol 2018; 4:180-184. [PMID: 30175224 PMCID: PMC6116820 DOI: 10.1016/j.ijwd.2018.04.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 04/04/2018] [Accepted: 04/06/2018] [Indexed: 01/06/2023] Open
Abstract
Background Lichen planopilaris (LPP) is a rare, cicatricial, lymphocyte-mediated alopecia that is thought to have an autoimmune pathogenesis and possibly related to other autoimmune diseases. However, data are limited and studies that examine comorbid conditions are lacking. Objectives We sought to determine the prevalence of systemic comorbid conditions, nutritional deficiencies, psychological problems, and skin cancers in patients with LPP. Methods We identified 334 patients with LPP who were seen in the Department of Dermatology at the Cleveland Clinic Foundation between 2000 and 2016. Patients with LPP were compared with 78 control patients with a diagnosis of seborrheic dermatitis. Results There were more female patients with LPP compared with the controls (93.1% vs. 79.5%; p < .001) but the average age did not differ (54.77 ± 12.83 vs. 52.19 ± 15.37; p = .12). Conditions positively associated with LPP were Hashimoto’s thyroiditis (6.3% vs. 0%; p = .023), hypothyroidism (24.3% vs. 12.8%; p = .028), and hirsutism (11.4% vs. 1.3%; p = .006). Negatively associated conditions were allergic rhinitis (15% vs. 24.4%; p = .046), diabetes mellitus type II (11.7% vs. 21.8%; p = .019), hyperlipidemia (38.6% vs. 52.6%; p = .024), vitamin D deficiency (50% vs. 65.4%; p = .014), depression (15.6% vs. 28.9%; p = .018), and sleep problems (7.5% vs. 29.5%; p < .001). Conclusions Our study further emphasizes that dermatologists should screen patients with LPP for autoimmune disorders that are associated with LPP and complete a full metabolic workup to avoid missing other abnormalities. The importance of atopy, autoimmune disorders, endocrine disorders, nutritional deficiencies, psychological problems, and skin cancers in patients with scarring alopecia should be better understood.
Collapse
Affiliation(s)
- N Brankov
- Department of Dermatology and Dermatopathology, Cleveland Clinic Foundation, Cleveland, Ohio
| | - R Z Conic
- Department of Dermatology and Dermatopathology, Cleveland Clinic Foundation, Cleveland, Ohio.,Department of Dermatology, Case Western Reserve University, Cleveland, Ohio
| | - N Atanaskova-Mesinkovska
- Department of Dermatology and Dermatopathology, Cleveland Clinic Foundation, Cleveland, Ohio.,Department of Dermatology and Dermatopathology, University of California Irvine, Irvine, California
| | - M Piliang
- Department of Dermatology and Dermatopathology, Cleveland Clinic Foundation, Cleveland, Ohio
| | - W F Bergfeld
- Department of Dermatology and Dermatopathology, Cleveland Clinic Foundation, Cleveland, Ohio
| |
Collapse
|
4
|
Diamante C, Bergfeld WF, Belsito DV, Klaassen CD, Marks JG, Shank RC, Slaga TJ, Snyder PW, Alan Andersen F. Final Report on the Safety Assessment of Basic Violet 1, Basic Violet 3, and Basic Violet 4. Int J Toxicol 2010; 28:193S-204S. [DOI: 10.1177/1091581809354649] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
5
|
Robinson V, Bergfeld WF, Belsito DV, Klaassen CD, Marks JG, Shank RC, Slaga TJ, Snyder PW, Alan Andersen F. Amended Safety Assessment of Tall Oil Acid, Sodium Tallate, Potassium Tallate, and Ammonium Tallate. Int J Toxicol 2010; 28:252S-8S. [DOI: 10.1177/1091581809354652] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
6
|
Sellheyer K, Bergfeld WF. Is it Appropriate for Nondermatologist Physicians to Perform Skin Biopsies? J Cutan Pathol 2008. [DOI: 10.1111/j.0303-6987.2005.320gu.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
7
|
Lin L, Bergfeld WF. Cutaneous Rosai-Dorfman Disease. J Cutan Pathol 2008. [DOI: 10.1111/j.0303-6987.2005.320ee.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
8
|
Sigel JE, Skacel M, Bergfeld WF, House NS, Rabkin MS, Goldblum JR. The utility of cytokeratin 5/6 in the recognition of cutaneous spindle cell squamous cell carcinoma. J Cutan Pathol 2001; 28:520-4. [PMID: 11737521 DOI: 10.1034/j.1600-0560.2001.281005.x] [Citation(s) in RCA: 73] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Cutaneous spindle cell squamous cell carcinoma (SSCC) is a challenging diagnosis since it may be difficult to distinguish from spindle cell melanoma, leiomyosarcoma and atypical fibroxanthoma. Furthermore, it may be difficult to demonstrate epithelial differentiation by a traditional immunohistochemical panel. We performed an expanded immunohistochemical evaluation of ultrastructurally documented SSCC to assess its utility in diagnosing this entity. METHODS We identified 16 cases of SSCC that were composed predominantly of spindle-shaped cells and with ultrastructural evidence of epithelial differentiation (i.e. at least rudimentary cell junctions). Immunohistochemical analysis using antibodies to a variety of cytokeratins (AE1/3, K903, CK5/6) and S-100 protein was performed. The extent of immunostaining was graded on a scale of 0 to 4+ (0: no staining; 1+: < or =25%; 2+: 26-50%; 3+: 51-75%; 4+: >75%). RESULTS Of the 16 cases, 6 expressed AE1/3 (38%), 8 expressed K903 (50%) and 11 (69%) expressed CK5/6. Six cases were positive for all three CK markers and two cases were positive for both K903 and CK5/6 but negative for AE1/3. Three cases (19%) stained for CK5/6 without any staining for AE1/3 or K903. Five cases (31%) were negative for all epithelial markers. The extent of CK5/6 staining was either similar to or greater than K903 staining in 7 of 8 cases that stained with both markers. All 16 cases were negative for S-100 protein. CONCLUSIONS Including CK5/6 in the initial battery of immunostains performed on a cutaneous spindle cell neoplasm can help demonstrate epithelial differentiation in SSCC, even in the absence of AE1/3 or K903 staining. However, some cases of cutaneous SSCC can only be confirmed ultrastructurally, as up to one-third may not show evidence of epithelial differentiation using an expanded immunohistochemical panel.
Collapse
Affiliation(s)
- J E Sigel
- The Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA
| | | | | | | | | | | |
Collapse
|
9
|
Ormsby A, Bergfeld WF, Tubbs RR, Hsi ED. Evaluation of a new paraffin-reactive CD7 T-cell deletion marker and a polymerase chain reaction-based T-cell receptor gene rearrangement assay: implications for diagnosis of mycosis fungoides in community clinical practice. J Am Acad Dermatol 2001; 45:405-13. [PMID: 11511839 DOI: 10.1067/mjd.2001.116342] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND T-cell deletion and T-cell receptor (TCR) gene rearrangement studies are helpful in the early diagnosis and subsequent management of mycosis fungoides (MF). However, this often requires fresh-frozen tissue that can be difficult to obtain and evaluate in community clinical practice. A new CD7 antibody, the most sensitive and specific T-cell deletion marker, and a new TCR-gamma gene rearrangement polymerase chain reaction (PCR) assay (TCR-gamma PCR) are now available on routine paraffin-embedded biopsy specimens. OBJECTIVE Our purpose was to assess the utility of CD7 deletion and TCR-gamma PCR in the diagnosis of MF using routine paraffin-embedded biopsy material. METHODS Cases of MF (n = 17) with matching frozen tissue immunohistochemistry and benign reactive dermatoses (lichen planus; n = 27) were assessed for CD7 (Clone: CD7-272) deletion and TCR-gamma PCR using paraffin-embedded biopsy specimens. RESULTS Excellent concordance comparing frozen and paraffin embedded CD7 immunostaining (88%) was observed. CD7 deletion and TCR-gamma PCR was sensitive (94%) and specific (96%) for a diagnosis of MF using paraffin-embedded biopsy specimens. CONCLUSION In the diagnosis of MF, detection of CD7 deletion and monoclonal TCR rearrangements can be successfully performed in a cost-effective, timely fashion using routine formalin-fixed paraffin-embedded biopsy specimens.
Collapse
Affiliation(s)
- A Ormsby
- Department of Anatomic Pathology and Dermatology, The Cleveland Clinic Foundation, 9500 Euclid Ave., Cleveland, OH 44195, USA
| | | | | | | |
Collapse
|
10
|
Mulinari-Brenner F, Bergfeld WF. Hair loss: an overview. Dermatol Nurs 2001; 13:269-72, 277-8. [PMID: 11917783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
Hair loss is a common problem in men and women. Correct diagnosis of hair disorders is complex and requires evaluation of clinical presentation, history, physical examination, and laboratory tests. Hair loss may be categorized as hair shaft abnormalities, permanent alopecia, or nonpermanent alopecia. Nonpermanent alopecia, the most common type, includes androgenetic alopecia, telogen effluvium, alopecia areata, and traction alopecia. The hallmark of this group is the possibility of complete regrowth with adequate treatment.
Collapse
Affiliation(s)
- F Mulinari-Brenner
- Departments of Dermatology and Pathology, Cleveland Clinic Foundation, Cleveland, OH, USA
| | | |
Collapse
|
11
|
Abstract
Cutaneous mastocytosis appears to occur sporadically; however, familial inheritance has been reported in 50 families since the mid-1880s. We report four cases of telangiectasia macularis eruptiva perstans (TMEP) occurring in three generations of a family. Whereas most patients with TMEP manifest in adulthood, all of the members of this family developed initial lesions during childhood. This is the third documented instance of familial mastocytosis affecting members of three generations, and the first report of familial TMEP. Although the inheritance pattern is unknown, the presentation of disease in this family further supports the hypothesis of an autosomal dominant mode of transmission with incomplete penetrance.
Collapse
Affiliation(s)
- A Chang
- Department of Dermatology, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA
| | | | | | | | | | | |
Collapse
|
12
|
Abstract
Although telogen effluvium, or shedding-the most common type of diffuse hair loss in both women and men-is usually self-limiting, the condition may become chronic if the trigger is not identified and corrected. The authors discuss the physiologic and emotional triggers, clinical presentation, diagnosis, and management strategies, including the importance of patient education and reassurance.
Collapse
Affiliation(s)
- W F Bergfeld
- Department of Dermatology, Cleveland Clinic, Cleveland Clinic Foundation, OH 44195, USA.
| | | |
Collapse
|
13
|
Helm TN, Bisker E, Bergfeld WF. Lipodystrophy. Cutis 2001; 67:163-4. [PMID: 11236228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
Congenital lipodystrophy is an uncommon autosomal recessive disorder that occurs mainly in females and is characterized by loss of subcutaneous fat, insulin-dependent diabetes mellitus, and masculinization due to defective metabolism of fat. Acquired lipodystrophy is now most commonly encountered in patients infected with HIV who take protease inhibitors. We present an illustrative case of lipodystrophy and review the presenting signs allowing for an accurate clinical diagnosis.
Collapse
Affiliation(s)
- T N Helm
- Department of Dermatology, Buffalo Medical Group, 6255 Sheridan Dr, Bldg B, Suite 208, Williamsville, NY 14221, USA
| | | | | |
Collapse
|
14
|
Abstract
Hirsutism should be considered part of the androgen-excess syndrome unless another cause (e.g., masculinizing tumor, androgenic-drug use) can be established. Medical evaluation for transient or late-onset androgen excess, polycystic ovary syndrome, and insulin resistance is important because of the risks associated with chronic androgen excess. Treatment of insulin resistance with antiandrogen and/or insulin-lowering therapy can reduce ovarian testosterone levels and hirsutism. Simple laboratory evaluation (i.e., measuring total and free testosterone, DHEAS, and androstenedione) identifies about half of patients with hyperandrogenism. More extensive evaluation and testing are required in the remaining half. Combination therapies, specifically oral contraceptives along with antiandrogen agents, are the most effective. Studies suggest that addition of low-dose GnRH agonist therapy prolongs remission of hirsutism. Most methods produce improvement within 6 months, with continued improvement at 12 months. Successful treatment results in finer hair, decreased rate of growth, decreased need for cosmetic camouflage or removal, and improved appearance. All methods, whether used continuously or intermittently, should be considered long term.
Collapse
Affiliation(s)
- W F Bergfeld
- Department of Dermatology, Cleveland Clinic, OH 44195, USA.
| |
Collapse
|
15
|
Abstract
Posttransplant lymphoproliferative disorder (PTLD) is a known complication of solid organ and bone marrow transplantation. However, cutaneous manifestation is an extremely rare phenomenon of this disorder. We describe a lung transplantation patient with cutaneous PTLD who presented with bilateral extremity nodules and fever.
Collapse
Affiliation(s)
- K W Schumann
- Departments of Dermatology and Pathology, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | | | | | | | | |
Collapse
|
16
|
Abstract
UNLABELLED Dermatofibrosarcoma protuberans (DFSP) is a fibrohistiocytic tumor of intermediate malignancy characterized by a distinctive storiform growth pattern and frequent local recurrences. In this study, we retrospectively reviewed 48 cases of DFSP diagnosed at the Cleveland Clinic Foundation between 1970 and 1999 to determine the prevalence of morphologic variations including the presence of giant cell fibroblastoma (GCF)-like areas, multinucleated giant cells, hypercellular zones and fibrosarcomatous change. RESULTS The cohort consisted of 42 patients (20 males, 22 females) with a median age at diagnosis of 40 years (range: 10-73 years). Forty-one primary tumors and seven recurrences were evaluated from these 42 patients. Tumor sites included the trunk (22 cases), head and neck (8 cases), upper extremities (7 cases) and lower extremities (6 cases). GCF-like areas were identified in seven (14.6%), multinucleated giant cells in ten (20.8%), hypercellular zones in 12 (25%) and fibrosarcomatous change in six (12.5%) cases, respectively. Combinations included giant cells and GCF-like areas (two cases), giant cells and hypercellular zone (two cases), and GCF-like areas and hypercellular zones (one case). Our findings suggest that DFSP has a wider range of morphologic features, including GCF-like areas, multinucleated giant cells, hypercellular zones and fibrosarcomatous change, than has been previously recognized in the literature.
Collapse
Affiliation(s)
- J E Sigel
- Department of Anatomic Pathology, The Cleveland Clinic Foundation, Ohio, USA
| | | | | |
Collapse
|
17
|
Abstract
alpha-Hydroxy acid (AHA) peels and home regimens have recently been recognized as important adjunctive therapy in a variety of conditions including photodamage, actinic damage, melasma, hyperpigmentation disorders, acne, and rosacea. Overall in our experience and in the literature, AHAs have a proven level of safety and efficacy in a variety of skin types. Although their exact mechanism of action is unknown, it has been demonstrated that AHAs improve these disorders by thinning the stratum corneum, promoting epidermolysis, dispersing basal layer melanin, and increasing collagen synthesis within the dermis. In patients with photodamage, AHA peels and topical products are often combined with retinoids and other antioxidants for maximum benefit. Similarly, synergistic effects of fluorouracil and glycolic acid are observed in the treatment of diffuse actinic keratoses. For patients with melasma, AHA peels and combination products containing bleaching agents such as hydroquinone, kojic acid, and glycolic acid seem to have increased efficacy. Acne and rosacea patients can see improved results when standard regimens like antibacterials and topical retinoids are supplemented with AHA peels and lotions. However, care should always be taken prior to commencing treatment with AHA peels and topical products. By obtaining a thorough history and physical examination, the physician will identify any specific factors like medications, prior procedures and medical conditions which can affect the outcome of the peel. During the interview, there should be open discussion of patient questions and concerns so that realistic expectations can be made. Pre- and post-peel regimens should also be reviewed in full as patient compliance is essential to ensure the success of a series of AHA peels.
Collapse
Affiliation(s)
- R C Tung
- Cleveland Clinic Foundation, Department of Dermatology, Cleveland, Ohio, USA
| | | | | | | |
Collapse
|
18
|
Abstract
A recent report suggests that elastic fibers appear in scars in a time-dependent fashion. This observation prompted our investigation, because we have found elastic tissue stains helpful in determining the pattern of scarring in cases of permanent alopecia. We carried out this investigation to determine if the Verhoeff-Van Gieson (VVG) elastic stain can reliably differentiate scarred from non-scarred dermis and to test our hypothesis that elastic stained sections are helpful in distinguishing lichen planopilaris (LPP) from lupus erythematosus (LE), central progressive alopecia in black females ("follicular degeneration syndrome" and "hot comb alopecia" are other terms used to describe this condition) and classic ivory white idiopathic pseudopelade. We studied histological sections from surgical scars of known duration, stained with the VVG elastic stain and VVG-stained sections of scalp biopsies from patients with established lesions of permanent alopecia. In most cases, both vertical and transverse sections were examined. In every case, the VVG stain clearly differentiated scar from the normal surrounding dermis. Distinct patterns of elastic tissue allowed for correct classification in most of the well-established cases of permanent alopecia studied. We determined that the Verhoeff-Van Gieson stain is an excellent stain to evaluate the pattern of scarring in cases of permanent alopecia and elastic tissue stains may be helpful in the histological evaluation of alopecia.
Collapse
Affiliation(s)
- D M Elston
- Department of Dermatology, Wilford Hall Air Force and Brooke Army Medical Centers, Fort Sam Houston, Texas 78234-6200, USA
| | | | | | | |
Collapse
|
19
|
Bergfeld WF. A lifetime of healthy skin: implications for women. Int J Fertil Womens Med 1999; 44:83-95. [PMID: 10338266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
During her lifetime, a woman faces the possibility of seeking dermatological assistance for a myriad of conditions, including acne, rosacea, striae, photodamage, and skin cancers. It is important for clinicians and patients to be aware of the symptoms of these conditions as well as the most beneficial approaches for prevention, diagnosis, treatment, and management. The life expectancy of women has increased and predictions for the year 2050 estimate the average age at 81 years. This will place women at greater risk for dermatological problems, especially photodamage and skin cancer. In addition, various ethnic groups may manifest these conditions differently. Although acne is most prevalent among teenaged males, most can expect clearing by age 25. Females may continue to experience acne into the adult years, sometimes beyond the age of 40. Although it is not a life-threatening disease, acne may have psychosocial and quality-of-life consequences. Treatments for acne can be topical or systemic, and include retinoids, antibiotics, benzoyl peroxide, azelaic acid, and hormonal therapy. Rosacea is more common in women (especially during menopause) than in men. It is a chronic condition that can cause complications, including telangiectasia, conjunctivitis, and blepharitis. Although there is no cure, rosacea can be managed and controlled with medication. Topical antibiotics, such as metronidazole, and systemic antibiotics, such as tetracycline, clarithromycin, and doxycycline, are used to manage rosacea. Striae, or stretch marks, occur most frequently in pregnant women, adolescents experiencing growth spurts, weight lifters, and the obese. Although not a health threat, they can be psychologically distressing. There are not many treatment options for striae, but topical tretinoin and the pulsed dye laser offer promising results. Intrinsic, or normal, aging of the skin results from the process of chronological aging. Photodamage is skin damage caused by chronic exposure to ultraviolet (UV) light. It is the leading cause of extrinsic aging, or alterations of the skin due to environmental exposure. Estimates indicate that almost half of a person's UV exposure occurs by age 18. Photoaging causes numerous histologic, physiologic, and clinical changes; it also increases the risk for skin cancer. Photodamage can be prevented through the use of sun screens, protective clothing, and avoidance of the sun during peak intensity time. The only product approved by the FDA for the treatment of photodamage (fine wrinkles, mottled hyperpigmentation, and skin roughness), topical tretinoin emollient cream, may help prevent additional photoaging when it is used to treat existing photoaging. Other management options for photodamaged skin include alpha-hydroxy acids, antioxidants, antiandrogens, moisturizers, and exfoliants. In patients with excessive manifestations of photodamage, surgical management may be needed, including dermabrasion, chemical peels, soft tissue augmentation, laser resurfacing, botulism toxin, and Gortex threads. Clinicians must educate their patients about the most appropriate skin care regimen as well as approaches for preventing and treating common afflictions. In this way, women will have the best opportunity for having and maintaining healthy skin.
Collapse
Affiliation(s)
- W F Bergfeld
- Department of Dermatology and Pathology, The Cleveland Clinic Foundation, Ohio 44106, USA
| |
Collapse
|
20
|
Harris BD, Primka EJ, Hollandsworth KJ, Bergfeld WF. Pigmented purpuric dermatosis in a young male. Cutis 1999; 63:112-3. [PMID: 10071745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
The pigmented purpuric dermatoses (PPD) are a group of disorders that most often occur on the lower extremities of middle-aged adults as asymptomatic, yellow-orange patches with petechiae. The PPD represent a benign, often chronic, capillaritis of unknown cause. We present a case of PPD on the abdomen of a young male and emphasize careful observation in such a patient to reveal possible progression to purpuric mycosis fungoides.
Collapse
Affiliation(s)
- B D Harris
- Cleveland Clinic Foundation, Department of Dermatology, Ohio 44195, USA
| | | | | | | |
Collapse
|
21
|
Affiliation(s)
- W F Bergfeld
- Department of Dermatology, Cleveland Clinic Foundation, Ohio 44106, USA
| |
Collapse
|
22
|
Terezhalmy GT, Bergfeld WF. Cicatricial pemphigoid (benign mucous membrane pemphigoid). Quintessence Int 1998; 29:429-37. [PMID: 9759059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Cicatricial pemphigoid is a chronic mucocutaneous bullous condition. It is a heterogenous autoimmune disease, characterized by the production of autoantibodies against basement membrane zone antigens. The target antigens in cicatricial pemphigoid appear to be lamina lucida proteins involved in human keratinocyte adhesion to extracellular matrix. Cicatricial pemphigoid primarily affects persons older than 40 years and appears to have a 2:1 predilection for women, without racial or geographic bias.
Collapse
Affiliation(s)
- G T Terezhalmy
- Department of Dentistry, Cleveland Clinic Foundation, Ohio 44195, USA
| | | |
Collapse
|
23
|
Ling MR, Swinyer LJ, Jarratt MT, Falo L, Monroe EW, Tharp M, Kalivas J, Weinstein GD, Asarch RG, Drake L, Martin AG, Leyden JJ, Cook J, Pariser DM, Pariser R, Thiers BH, Lebwohl MG, Babel D, Stewart DM, Eaglstein WH, Falanga V, Katz HI, Bergfeld WF, Hanifin JM, Young MR. Once-weekly fluconazole (450 mg) for 4, 6, or 9 months of treatment for distal subungual onychomycosis of the toenail. J Am Acad Dermatol 1998; 38:S95-102. [PMID: 9631991 DOI: 10.1016/s0190-9622(98)70492-x] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Fluconazole is a bis-triazole antifungal agent approved for the treatment of oropharyngeal, esophageal, and vaginal candidiasis, serious systemic candidal infections, and cryptococcal meningitis. OBJECTIVE The purpose of this study was to evaluate three different durations of once-weekly fluconazole for the treatment of onychomycosis of the toenail caused by dermatophytes. METHODS In a multicenter, randomized, double-blind, parallel, placebo-controlled trial, 384 patients with distal subungual onychomycosis of the toenail received fluconazole, 450 mg once weekly, or placebo for 4, 6, or 9 months. For inclusion, patients were required to have mycologically confirmed distal subungual onychomycosis of the toenail with a large toenail at least 25% clinically affected but having at least 2 mm of healthy nail between the nail fold and the proximal onychomycotic border. Efficacy was assessed by clinical and mycologic (microscopic and microbiologic) measures at screening, at every treatment visit starting at month 3, and at months 2, 4, and 6 after therapy. Observed or volunteered adverse events were recorded and classified at all visits. RESULTS At the end of treatment, very significantly superior clinical and mycologic results were achieved in all fluconazole groups compared with placebo (p=0.0001). This superiority was largely maintained over 6 months of follow-up. The clinical and mycologic responses of the 9-month treatment duration were significantly superior to the 4- and 6-month durations. Similar percentages of patients in the fluconazole and placebo groups reported adverse experiences for all three durations of the study. CONCLUSION Results of this study support the efficacy and safety of fluconazole in the treatment of distal subungual onychomycosis of the toenail.
Collapse
Affiliation(s)
- M R Ling
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia 30322, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
24
|
Robinson JK, Amonette R, Wyatt SW, Bewerse BA, Bergfeld WF, Farris PK. Executive summary of the national "Sun Safety: Protecting Our Future" Conference: American Academy of Dermatology and Centers for Disease Control and Prevention. New York, New York, May 1 and 2, 1997. J Am Acad Dermatol 1998; 38:774-80. [PMID: 9591830 DOI: 10.1016/s0190-9622(98)70213-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
|
25
|
Helm T, Spigel GT, McMahon J, Bergfeld WF. Striate palmoplantar keratoderma: a clinical and ultrastructural study. Cutis 1998; 61:18-20. [PMID: 9466074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Palmoplantar keratodermas are poorly understood heterogeneous disorders of cornification. Autosomal dominant and autosomal recessive keratodermas with a varied clinical presentation are recognized. Striate keratoderma is uncommon. We report the case of a 15-year-old girl with keratoderma that began at 5 months of age. Her clinical and ultrastructural findings are reviewed. Routine microscopic examination revealed eosinophilic inclusions in the granular cell layer as well as prominence of the granular cell layer. Electron microscopic examination revealed corneocytes with an imbricated pattern. Ultrastructural findings in this unique case are contrasted with those of other palmoplantar keratodermas.
Collapse
Affiliation(s)
- T Helm
- Department of Dermatology, Buffalo Medical Group, New York, USA
| | | | | | | |
Collapse
|
26
|
Affiliation(s)
- T N Helm
- Department of Dermatology, Buffalo Medical Group, Williamsville, New York 14221, USA
| | | |
Collapse
|
27
|
Ruddock TL, Rindler JM, Bergfeld WF. Capnocytophaga canimorsus septicemia in an asplenic patient. Cutis 1997; 60:95-7. [PMID: 9283773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
We present a classic case of Capnocytophaga canimorsus septicemia. C. canimorsus (from the Latin canis, dog; and morsus, a bite), formerly called CDC group DF-2, is a gram-negative rod that typically causes septicemia with disseminated intravascular coagulation in both immunocompromised and immunocompetent hosts.
Collapse
|
28
|
Primka EJ, Mark J, Bergfeld WF. Stump the experts. Cellular dermatofibroma. Dermatol Surg 1997; 23:711-3. [PMID: 9256921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- E J Primka
- Department of Dermatology, Cleveland Clinic Foundation, Ohio 44195, USA
| | | | | |
Collapse
|
29
|
Blodgett TP, Camisa C, Gay D, Bergfeld WF. Acute generalized exanthematous pustulosis secondary to diltiazem therapy. Cutis 1997; 60:45-7. [PMID: 9252736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Acute generalized exanthematous pustulosis in a rare pustular exanthem that is most commonly drug induced. We report a case occurring secondary to diltiazem therapy and briefly review the typical characteristics of this entity.
Collapse
Affiliation(s)
- T P Blodgett
- Department of Dermatology, Cleveland Clinic Foundation, Ohio 44195, USA
| | | | | | | |
Collapse
|
30
|
Elston DM, McCollough ML, Bergfeld WF, Liranzo MO, Heibel M. Eosinophils in fibrous tracts and near hair bulbs: a helpful diagnostic feature of alopecia areata. J Am Acad Dermatol 1997; 37:101-6. [PMID: 9216531 DOI: 10.1016/s0190-9622(97)70219-6] [Citation(s) in RCA: 50] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND When biopsy specimens lack a "swarm of bees" peribulbar lymphoid infiltrate, the diagnosis of alopecia areata depends on the recognition of other histologic features of the disease. OBJECTIVE Our objective was to determine the frequency of the presence of eosinophils in biopsy specimens of alopecia area'a in relation to the other major histologic features of the disease. METHODS Biopsy specimens from 71 patients with alopecia areata were studied. RESULTS Eosinophils were present in 38 of the 71 cases. A peribulbar lymphoid infiltrate was absent in 27 of the 71 cases. Eosinophils were present in 13 of these cases. Multiple catagen hairs and pigment casts (features which may lead to confusion with trichotillomania) were present in 39 cases. The presence of eosinophils was found to be a helpful diagnostic feature in cases with potential for misdiagnoses as trichotillomania. CONCLUSION Eosinophils are common in all stages of alopecia areata, both within the peribulbar infiltrate and within fibrous tracts. A "swarm of bees" peribulbar infiltrate may be absent. The presence of eosinophils is a helpful diagnostic feature of alopecia areata.
Collapse
Affiliation(s)
- D M Elston
- Dermatology Service, Wilford Hall Air Force, TX, USA
| | | | | | | | | |
Collapse
|
31
|
Abstract
Frequent and daily use of cosmetic and skin-care products that contain alpha-hydroxy acids (AHAs) moisturizes the skin and produces smoother, less-wrinkled skin surfaces. The cosmetic products developed as astringents and exfoliants diminish skin scales and remove excess skin oil. New studies suggest that photodamaged skin improves with AHA treatment.
Collapse
Affiliation(s)
- D G Vidt
- Department of Dermatology, Cleveland Clinic Foundation, OH 44195, USA
| | | |
Collapse
|
32
|
Schlesinger TE, Camisa C, Gay JD, Bergfeld WF. Oral erosive lichen planus with epidermolytic hyperkeratosis during interferon alfa-2b therapy for chronic hepatitis C virus infection. J Am Acad Dermatol 1997; 36:1023-5. [PMID: 9204077 DOI: 10.1016/s0190-9622(97)80296-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- T E Schlesinger
- Department of Dermatology, Cleveland Clinic Foundation, OH, USA
| | | | | | | |
Collapse
|
33
|
Bergfeld WF, Farris PK, Wyatt SW, Reilley B, Bewerse BA, Koh HK. Executive summary of the national Partners in Prevention Skin Cancer Conference: American Academy of Dermatology and Centers for Disease Control and Prevention. J Am Acad Dermatol 1997; 36:798-801. [PMID: 9146552 DOI: 10.1016/s0190-9622(97)80355-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
|
34
|
Bergfeld WF. The aging skin. Int J Fertil Womens Med 1997; 42:57-66. [PMID: 9160214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
In the past, sun exposure has been an integral part of the American life style. Along with increased leisure time, outdoor recreational sports, and sun bathing has come greater exposure to the sun. The cumulative effects of unprotected sun exposure coupled with the changes in the ozone layer have resulted in a large photodamaged population and an epidemic of the most dangerous skin cancer, malignant melanoma. Photodamage begins early, with a child's first unprotected sun exposure. Clinical studies show that 50% of an individual's ultraviolet light exposure occurs before the age of 18 years. This damage from acute and chronic ultraviolet light exposure has produced the explosion of skin cancers. Over the next 4 years, it is expected that skin cancer will become the most common type of cancer, and malignant melanoma will become the leading cause of death from skin cancer. This growing hazard to the public has profound medical and psychological ramifications. This paper will focus on prevention, identification, evaluation and treatment of photodamage to skin, as well as skin cancer. Special emphasis will be given to the National Skin Cancer Prevention Education Program.
Collapse
Affiliation(s)
- W F Bergfeld
- Department of Dermatology, Cleveland Clinic Foundation, Ohio, USA
| |
Collapse
|
35
|
Affiliation(s)
- J M Newman
- Department of Dermatology, Cleveland Clinic Foundation, OH 44195-5032, USA
| | | | | | | |
Collapse
|
36
|
Affiliation(s)
- D M Elston
- Department of Pathology, Cleveland Clinic Foundation, USA
| | | | | | | | | |
Collapse
|
37
|
Goldsmith LA, Koh HK, Bewerse BA, Reilley B, Wyatt SW, Bergfeld WF, Geller AC, Walters PF. Full proceedings from the National Conference to Develop a National Skin Cancer Agenda. American Academy of Dermatology and Centers for Disease Control and Prevention, Washington, D.C., April 8-10, 1995. J Am Acad Dermatol 1996; 35:748-56. [PMID: 8912571 DOI: 10.1016/s0190-9622(96)90731-8] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
National efforts to reduce skin cancer incidence and mortality require scientifically coordinated efforts. This report summarizes the first American Academy of Dermatology/Centers for Disease Control and Prevention national conference to develop a skin cancer agenda. Leading experts in dermatology, public health, medicine, health education, nursing, behavioral sciences, environmental health and epidemiology identified and prioritized skin cancer control issues in five key areas. Discussion centered around strategies for reducing UV exposure and increasing public and professional awareness of skin cancer. Panelists in five sessions developed consensus on several public and professional recommendations and a series of research strategies.
Collapse
|
38
|
Omohundro C, Dijkstra JW, Camisa C, Bergfeld WF. Early onset pretibial myxedema in the absence of ophthalmopathy: a morphologic evolution. Cutis 1996; 58:211-4. [PMID: 8886536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Pretibial myxedema (PTM) is an uncommon, late manifestation of Graves' disease. It is nearly always preceded by significant ophthalmopathy and classically presents as nonpitting (brawny) edema of the lower extremities. We report a case of PTM that is unusual because of its morphologic evolution, that it occurred prior to the diagnosis of Graves' disease, and in the absence of ophthalmopathy.
Collapse
Affiliation(s)
- C Omohundro
- Department of Dermatology, Cleveland Clinic Foundation, Ohio, USA
| | | | | | | |
Collapse
|
39
|
Affiliation(s)
- R G Dufresne
- Mohs and Laser Unit, Roger Williams Medical Center, Brown University School of Medicine, Providence, RI, USA
| | | | | | | |
Collapse
|
40
|
Affiliation(s)
- A G Bridges
- Department of Dermatology, University of Cincinnati, OH, USA
| | | | | | | | | |
Collapse
|
41
|
Kahn TA, Liranzo MO, Vidimos AT, Papay FA, Bergfeld WF. Pathological case of the month. Congenital dermatofibrosarcoma protuberans. Arch Pediatr Adolesc Med 1996; 150:549-50. [PMID: 8620241 DOI: 10.1001/archpedi.1996.02170300103021] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- T A Kahn
- Department of Dermatology, Cleveland Clinic Foundation, Ohio, USA
| | | | | | | | | |
Collapse
|
42
|
Narurkar VA, Liranzo MO, Bergfeld WF, Camisa C. Amelanotic malignant melanoma disguised by Darier's disease (keratosis follicularis). Dermatol Surg 1996; 22:479-80. [PMID: 8634813 DOI: 10.1111/j.1524-4725.1996.tb00351.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
|
43
|
Ruxin TA, Steck WD, Helm TN, Bergfeld WF, Bolwell BJ. Pseudallescheria boydii in an immunocompromised host. Successful treatment with debridement and itraconazole. Arch Dermatol 1996; 132:382-4. [PMID: 8629840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- T A Ruxin
- Cleveland Clinic Foundation, OH, USA
| | | | | | | | | |
Collapse
|
44
|
Kuivaniemi H, Tromp G, Bergfeld WF, Kay M, Helm TN. Ehlers-Danlos syndrome type IV: a single base substitution of the last nucleotide of exon 34 in COL3A1 leads to exon skipping. J Invest Dermatol 1995; 105:352-6. [PMID: 7665911 DOI: 10.1111/1523-1747.ep12320704] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The Ehlers-Danlos syndrome has been classified into nine phenotypic presentations. Type IV is a variant of particular importance because people affected with this genodermatosis are at great risk of spontaneous hemorrhage from vascular rupture or bowel perforation. Recent molecular advances have identified mutations in the gene for type III procollagen as responsible for Ehlers-Danlos syndrome type IV. We report a case of a 14-year-old male with a typical presentation of the type IV variant who was found to have markedly dilated fibroblast cisternae and varying collagen fibril diameter on ultrastructural study. A novel genetic defect was noted by polymerase chain reaction and DNA sequencing of genetic material isolated from skin fibroblast cultures. Analysis of the gene for type III procollagen revealed a single base mutation in the last nucleotide of exon 34. The mutation led to abnormal RNA splicing and skipping of exon 34 on the mRNA level.
Collapse
Affiliation(s)
- H Kuivaniemi
- Department of Biochemistry and Molecular Biology, Jefferson Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | | | | | | | | |
Collapse
|
45
|
Chang LW, Liranzo M, Bergfeld WF. Cutaneous side effects associated with interferon-alpha therapy: a review. Cutis 1995; 56:144. [PMID: 8565597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Interferon-alpha is a unique biological protein whose clinical use, both in dermatology and other fields of medicine, has greatly increased over the past several years. We present a review of the cutaneous side effects reported with the use of interferon-alpha.
Collapse
Affiliation(s)
- L W Chang
- Department of Dermatology, Cleveland Clinic Foundation, Ohio 44195, USA
| | | | | |
Collapse
|
46
|
Affiliation(s)
- J Clark
- Cleveland Clinic Foundation, Ohio
| | | | | |
Collapse
|
47
|
Affiliation(s)
- W F Bergfeld
- Department of Dermatology and Pathology, Cleveland Clinic Foundation, OH 44106, USA
| |
Collapse
|
48
|
Kuhn CA, Helm TN, Bergfeld WF, Glanz S, Steck WD. Acneiform papules on the neck. Elastosis perforans serpiginosa (EPS). Arch Dermatol 1995; 131:341, 344. [PMID: 7887667 DOI: 10.1001/archderm.131.3.341b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- C A Kuhn
- Cleveland (Ohio) Clinic Foundation
| | | | | | | | | |
Collapse
|
49
|
Abstract
BACKGROUND The proliferation of non-Langerhans cell histiocytes is a poorly understood process of unknown cause. Variation in the clinical features and/or histopathology of histiocytic proliferation has led to subclassification of the general category of non-Langerhans cell histiocytes. Although the current classification may provide some useful generalizations in regard to the anticipated clinical course, wide variability in presentation and outcome make this classification less than optimal when dealing with individual patients. The objectives of the study were to present four cases of generalized non-Langerhans cell histiocytosis. MATERIALS AND METHODS Medical records and slides of four patients diagnosed with non-Langerhans cell histiocytosis at the Cleveland Clinic are reviewed. RESULTS The patients exhibit features of more than one subtype of non-Langerhans cell histiocytosis. CONCLUSION The overlap among the clinical and histologic features of the generalized cutaneous non-Langerhans cell histiocytic disorders suggests that they represent one disease entity with a wide spectrum of presentations rather than many distinct disorders.
Collapse
Affiliation(s)
- E A Mullans
- Department of Internal Medicine of Baylor University, College of Medicine, Houston, Texas, USA
| | | | | | | | | | | |
Collapse
|
50
|
Abstract
A hereditary, androgen-driven disorder, androgenetic alopecia is the most common form of alopecia in humans: its prevalence is 23-87%. Central alopecia is more severe in men; women are more likely to experience diffuse thinning. The acute onset of alopecia in those with inflammatory diseases of the scalp suggests a variety of etiologies, including the impact of inflammatory cells, release of cytokines, presence of growth factors, and increased interaction of stromal cells. Therapeutic modalities, which are most effective when used in combinations, utilize hair growth promoters, antiandrogens, and androgen blockade agents.
Collapse
Affiliation(s)
- W F Bergfeld
- Department of Dermatology, Cleveland Clinic Foundation, Ohio 44195-5032
| |
Collapse
|